患者参与患者安全的系统评价

Patients for Patient Safety:A Systematic Review

目的系统评价国内外患者参与患者安全的相关研究,并与我国患者参与患者安全的研究现状进行比较,为如何在我国开展患者参与患者安全教育,改进医疗质量提供循证决策建议。方法电子检索MEDLINE、EMbase、CBM,并追索纳入文献的参考文献,根据预先制定的纳入和排除标准筛选文献、提取数据,采用Cochrane Handbook 5.0和Critical Appraisal Skills Programme评价标准分析文献质量,采用定性研究方法综合分析资料。结果共纳入28篇文献,其中中文5篇,除1篇为随机对照试验外,其余均为横断面研究。定量或定性结果显示:①患者对患者安全的认知度国内外都普遍贫乏,但患者参与患者安全的意愿较为强烈;②患者参与的影响因素包括特征、疾病、情感;③3篇文献分别从感染、医疗差错、用药方面分析了患者的参与方式;④患者参与能有效促进医务人员规范操作,预防不安全事件发生,减少伤害;⑤所纳入的5篇中文文献的研究内容仅涉及患者对患者安全的认识、参与态度及影响因素。结论目前关于患者参与患者安全的研究尚少,更缺乏高质量的随机对照试验验证患者参与方式的有效性,提示今后的研究应加强患者参与患者安全后效果的评价。

Objective To systematically review the abroad studies on patients for patient safety,and compare them with the current status of domestic studies,so as to provide suggestions for evidence-based strategic decision about how to conduct the education of patients for patient safety and improve the medical quality.Methods The databases of MEDLINE,EMbase and Chinese Biomedical Literature Database（CBM） were searched to identify the relevant studies and their references.Literatures were screened with data extraction in accordance with the predefined inclusive and exclusive criteria.The quality of literatures was assessed with the standard of Cochrane Handbook 5.0 and Critical Appraisal Skills Programme,and the data were comprehensively analyzed with qualitative research methods.Results Among 28 included studies,5 were Chinese literatures,1 was RCT,and the others were cross-sectional studies.The results showed that：a） Generally,the patients at home and abroad were poor in the awareness of patient safety,but they were eager to participate in the patient safety;b） Factors affecting patients＇ participation were their characteristics,disease-related,and emotional feelings;c） Three studies reported the methods of involving patients in patient safety from the aspects of infection,malpractice,and medication;d） Some studies showed that patients＇ participation could effectively promote the standardized operation of medical staffs,prevent unsafe events,and reduce damages;and e） The research contents of the included Chinese literatures were just related to the patients＇ awareness of patient safety,attitude to participation,and influencing factors.Conclusion？The limited studies relevant to patients for patient safety are short of high-quality RCTs for proving the effectiveness of patient participation methods,so it indicates that the stress should be laid on evaluating the effectiveness of patients for patient safety in future research.